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Adjust A1c For Anemia

Anemia And Hemoglobin A1c Level: Is There A Case For Redefining Reference Ranges And Therapeutic Goals?

Anemia And Hemoglobin A1c Level: Is There A Case For Redefining Reference Ranges And Therapeutic Goals?

Segun Adeoye, Sherly Abraham, Irina Erlikh, Sylvester Sarfraz, Tomas Borda and Lap Yeung. Abstract Background: Hemoglobin A1c (HbA1c) has been adopted by physicians as a surrogate for monitoring glycemic control. There exists concern that other factors beyond serum glucose concentration may affect glycation rates and by extrapolation HbA1c levels. Study Objectives: The study attempts to discern clinical differences in HbA1c levels in patients with anaemia compared to patients without anemia, quantifying and showing the direction of such differences. Study Design: Using a convenient sampling method and a set of inclusion and exclusion criteria, it examined (retrospectively) patterns in [Hb] and HbA1c in non-diabetics with and without anemia. Results: The study observed a statistically significant 0.4units (8%) difference in the mean HbA1c in anaemia vs. non-anaemic populations. Reference ranges of HbA1c for non-anaemic population and anaemia subtypes was computed. Computed ranges for anaemia group and its subgroups were significantly wider compared to non-anaemia population. Modest but statistically significant correction of anaemia did not result in significant changes in HbA1c. Discussion: i. The linear relationship between [Hb] and HbA1c holds true for anaemic and non-anaemia populations. ii. Non-diabetic, anaemic have a significantly lower mean HbA1c (5.3% vs. 5.7%), but a similar upper limit of reference range due to a higher variance. iii. The variance and proposed reference ranges for anaemia group and its subtypes was greater than in non-anaemia group, perhaps due to homogenization of clinically heterogeneous entities. iv. Modest correction anaemia did not cause significant change in HbAIc, perhaps the increase in [Hb] was too modest or persistence of correction Continue reading >>

Type 2 Diabetes Diagnosis Distorted Through Hba1c Due To Anemia

Type 2 Diabetes Diagnosis Distorted Through Hba1c Due To Anemia

New research shows that anemia could lead to a false diagnosis of type 2 diabetes if HbA1c is used as the diagnostic method. In the UK, HbA1c is advocated by the World Health Organisation (WHO) for diagnosing type 2 diabetes at a value of 6.5 per cent (48 mmol/mol). Anemia is a common condition in which a lack of iron in the body leads to decreased red blood cell count or hemoglobin in patients. An estimate from 2011 found that 29 per cent of non-pregnant women had anemia, while the latest WHO figures suggest this figure is 13 per cent in men. Researchers at the University of Nottingham investigated studies between 1990 and 2014 in which HbA1c and glucose were measured, as well as an index of anemia involving non-pregnant women not diagnosed with diabetes. 12 studies found that iron deficiency with or without anemia resulted in increased HbA1c values, while no corresponding blood glucose rise occurred. Subsequently, a diagnosis of diabetes would require further testing. The researchers recommend that when glucose and HbA1c levels differ in diabetic patients, anemia or iron deficiency should be considered. If these abnormalities are identified, correction of high hemoglobin levels should be corrected before HbA1c is again used for diagnosis or monitoring. "HbA1c is likely to be affected by iron deficiency and iron deficiency anaemia with a spurious increase in HbA1c values. This may lead to confusion when diagnosing diabetes using HbA1c," the authors say. "This review clearly identifies the need for more evidence, especially in identifying the types and degrees of anaemia likely to have significant impact on the reliability of HbA1c." Tweet Type 2 diabetes mellitus is a metabolic disorder that results in hyperglycemia (high blood glucose levels) due to the body: Being in Continue reading >>

Why Hemoglobin A1c Is Not A Reliable Marker

Why Hemoglobin A1c Is Not A Reliable Marker

i was recently tested for Hemoglobin A1c because i presented to an endocrinologist with extremely low blood glucose on lab test and some scary symptoms, not the ordinary hypoglycemia symptoms. My A1c was 4.7 which registered as low (L) on the lab print out–it was only slightly low. Does a low score on this suggest a possibility of short-lived RBCs? Does it have any relationship with extremely low blood glucose? my result at the lab, fasting, was 32mg/dL. Not long after that i got a home glucometer and i get the same kind of results on that as the lab got, in the 20s and 30s first thing in the morning, every day. did not know i had hypoglycemia until i had that lab test, though i had had one episode where i woke up with ataxia, i fell while walking to the bathroom first thing in the morning, i got up and immediately fell again. I soon found that i had very impaired coordination. i did not know why and i was very worried. Eventually i wanted to have breakfast but had great difficulty holding the measuring cup under the faucet, to get some water to heat, to make instant oatmeal, i lacked the coordination to get the water into the cup. I persisted and did make the instant oatmeal (pour hot water onto flakes and it’s done), and i got my lap top and was eating the oatmeal and i suddenly was aware that the symptoms were going away. Previously i had been unable to type. While eating the small amount of oatmeal, i realized i could type. That was about a month before the lab test. Since it only happened that once, i put it out of my mind. About 5 days after the lab test, i had the second episode, worse than the first, i woke falling out of bed to the floor, couldn’t use my arm to break the fall, i didn’t have the coordination. i sat on the floor, i could not get up and wa Continue reading >>

Glycosylated Hemoglobin (hba1c) And Anemia - General Practice Notebook

Glycosylated Hemoglobin (hba1c) And Anemia - General Practice Notebook

glycosylated hemoglobin (HbA1c) and anemia HbA1c is characterized and defined as hemoglobin that is irreversibly glycated at the N-terminal valine of the -chain HbA1c is an index used in the management of patients with diabetes HbA1c measurements rely on a predictable effect of glucose concentration on hemoglobin (Hb) over a normal red blood cell (RBC) life span - however any condition that alters RBC survival may invalidate HbA1c as an accurate measure of glycaemic control risk of misdiagnosis in those with iron-deficiency anemia and increased red blood cell turnover (e.g., haemolytic anemia or major blood loss) (1) iron-deficiency anemia is associated with higher concentrations of HbA1c among pediatric patients with type 1 diabetes despite similar levels of glycemia (1) iron replacement therapy can also result in a substantial drop in HbA1c in both diabetic and non-diabetic subjects (1) samples containing variant Hb cause erroneous results in measurement of HbA1c comparative analyses of HbA1c in samples containing Hb variants have shown that different test systems may give different results measurements of HbA1c percentages in subjects with Hb variants or high percentages of Hb derivatives may be affected differently in different methods decreased exposure time of Hb to circulating glucose concentrations will lead to truly decreased percentages for HbA1c, with erroneous interpretation when the condition is not recognized (2,3) for example with respect to sickle cell disease data from methods by HPLC and electrophoresis were variable, ranging from 'not detectable' to increased Continue reading >>

Iron-deficiency Anemia, Non-iron-deficiency Anemia And Hba1c Among Adults In The Us

Iron-deficiency Anemia, Non-iron-deficiency Anemia And Hba1c Among Adults In The Us

Conditions that affect erythrocyte turnover affect HbA1c concentrations. Although many forms of anemia are associated with lowering of HbA1c, iron deficiency tends to increase HbA1c. We examined the effect of iron and hemoglobin (Hb) status on HbA1c and on the relationship between concentrations of fasting glucose and HbA1c in a national sample of adults in the US.Cross-sectional data from 8296 adults aged 20 years who participated in NHANES 1999-2002 were used.The prevalence of low Hb (defined as <120 and < 118 g/L in women aged 20-69 and 70 years, respectively, and <137, <133, and < 124 g/L in men aged 20-49, 50-69, and 70 years, respectively) was 5.5%. There was a significant positive correlation between Hb concentrations and HbA1c concentrations after adjusting for age, gender, and race or ethnicity, with HbA1c rising from a mean of 5.28% among participants with Hb < 100 g/L to 5.72% among participants with Hb 170 g/L. The adjusted mean concentrations of HbA1c were 5.56% and 5.46% among participants with and without iron deficiency, respectively (P = 0.095). However, there was no evidence of differences in the relationship between fasting glucose and HbA1c when groups of anemic and non-anemic individuals with and without iron deficiency were examined individually.Caution should be used when diagnosing diabetes and prediabetes among people with high or low Hb when the HbA1c level is near 6.5% or 5.7%, respectively, as changes in erythrocyte turnover may alter the test result. However, the trend for HbA1c to increase with iron deficiency does not appear to require screening for iron deficiency in ascertaining the reliability of HbA1c in the diagnosis of diabetes and prediabetes in a given individual. Do you want to read the rest of this article? ... Coban and colleag Continue reading >>

Hemoglobin A1c

Hemoglobin A1c

Hemoglobin A1c (HbA1c) refers to a minor population of HbA that has been modified by attachment of glucose to the N-terminal amino acid of the beta globin chain. Since erythrocytes are freely permeable to glucose, the attachment occurs continually over the entire lifespan of the erythrocyte and is dependent on glucose concentration and the duration of exposure of the erythrocyte to blood glucose. HbA1c is a weighted average of blood glucose levels during the preceding 120 days, which is the average life span of red blood cells. A large change in mean blood glucose can increase HbA1c levels within 1-2 weeks. Sudden changes in HbA1c may occur because recent changes in blood glucose levels contribute relatively more to the final HbA1c levels than earlier events. For instance, mean blood glucose levels in the 30 days immediately preceding blood sampling contribute 50% to the HbA1c level, whereas glucose levels in the preceding 90-120 day period contribute only 10%. Thus, it does not take 120 days to detect a clinically meaningful change in HbA1c following a significant change in mean plasma glucose level. Hemoglobin A1c Methods Methods for analysis of HbA1c can essentially be divided into 2 categories depending on whether they measure HbA1c based upon charge or structure. The most common charge-based method utilizes cation-exchange high pressure liquid chromatography (HPLC). In this method, different hemoglobin molecules (eg, HbA, HbA2, HbF) are eluted from the column at different times following exposure to buffers of increasing ionic strength, depending on their charge. HbA1c is less positively charged than HbA and does not bind as tightly to the negatively charged resin. Therefore, it elutes more rapidly than HbA. The quantity of each Hb fraction in the eluate is quantit Continue reading >>

Effect Of Iron Deficiency Anemia On Hemoglobin A1c Levels

Effect Of Iron Deficiency Anemia On Hemoglobin A1c Levels

Go to: Abstract Background Iron deficiency anemia is the most common form of anemia in India. Hemoglobin A1c (HbA1c) is used in diabetic patients as an index of glycemic control reflecting glucose levels of the previous 3 months. Like blood sugar levels, HbA1c levels are also affected by the presence of variant hemoglobins, hemolytic anemias, nutritional anemias, uremia, pregnancy, and acute blood loss. However, reports on the effects of iron deficiency anemia on HbA1c levels are inconsistent. We conducted a study to analyze the effects of iron deficiency anemia on HbA1c levels and to assess whether treatment of iron deficiency anemia affects HbA1c levels. Fifty patients confirmed to have iron deficiency anemia were enrolled in this study. HbA1c and absolute HbA1c levels were measured both at baseline and at 2 months after treatment, and these values were compared with those in the control population. The mean baseline HbA1c level in anemic patients (4.6%) was significantly lower than that in the control group (5.5%, p<0.05). A significant increase was observed in the patients' absolute HbA1c levels at 2 months after treatment (0.29 g/dL vs. 0.73 g/dL, p<0.01). There was a significant difference between the baseline values of patients and controls (0.29 g/dL vs. 0.74 g/dL, p<0.01). Conclusions In contrast to the observations of previous studies, ours showed that HbA1c levels and absolute HbA1c levels increased with treatment of iron deficiency anemia. This could be attributable to nutritional deficiency and/or certain unknown variables. Further studies are warranted. Keywords: Iron deficiency anemia, Hemoglobin A1c, HbA1c, Glycated hemoglobin Go to: INTRODUCTION Hemoglobin A1c (HbA1c) is a glycated hemoglobin that can be used as an indicator of a patient's glycemic stat Continue reading >>

Payperview: Effect Of Iron Deficiency Anemia On The Levels Of Hemoglobin A1c In Nondiabetic Patients - Karger Publishers

Payperview: Effect Of Iron Deficiency Anemia On The Levels Of Hemoglobin A1c In Nondiabetic Patients - Karger Publishers

Effect of Iron Deficiency Anemia on the Levels of Hemoglobin A1c in Nondiabetic Patients Coban E.a Ozdogan M.a Timuragaoglu A.b Tel. +90 242 2274343 ext. 55139, Fax +90 242 2274490, E-Mail [email protected] I have read the Karger Terms and Conditions and agree. The major form of glycohemoglobin is hemoglobin A1c (HbA1c). The HbA1c fraction is abnormally elevated in chronic hyperglycemic diabetic patients and correlates positively with glycemic control. Previous studies suggest that iron deficiency anemia (IDA) affects the levels of HbA1c. The aim of this study was to determine the effect of IDA on HbA1c levels in nondiabetic patients. The population studied consisted of 50 patients (30 women, 20 men, mean age 35.7 11.9 years) with IDA and 50 healthy subjects that were matched for age and sex. Patients who had glucose tolerance abnormalities (impaired glucose tolerance or diabetes mellitus), hemoglobinopathies, hemolytic anemia, chronic alcohol ingestion and chronic renal failure were excluded from the study. Hematologic investigations, fasting and postprandial glucose and HbA1c levels were measured in all subjects before iron therapy. All patients with IDA were treated with iron 100 mg/day for 3 months. We repeated the laboratory investigation after iron therapy. Before iron treatment, the mean HbA1c (7.4 0.8%) level in patients with IDA was higher than in a healthy group (5.9% 0.5) (p < 0.001). In patients with IDA, HbA1c decreased significantly after iron treatment from a mean of 7.4% 0.8 to 6.2% 0.6 (p < 0.001). Iron deficiency must be corrected before any diagnostic or therapeutic decision is made based on HbA1c. De Rosa MC, Sanna MT, Messana I, Castagnola M, Galtieri A, Tellone E, Scatena R, Botta B, Botta M, Giardina B: Glycated human hemoglobin (HbA1c): Func Continue reading >>

Association Between Iron Deficiency And A1c Levels Among Adults Without Diabetes In The National Health And Nutrition Examination Survey, 1999–2006

Association Between Iron Deficiency And A1c Levels Among Adults Without Diabetes In The National Health And Nutrition Examination Survey, 1999–2006

OBJECTIVE Iron deficiency has been reported to elevate A1C levels apart from glycemia. We examined the influence of iron deficiency on A1C distribution among adults without diabetes. RESEARCH DESIGN AND METHODS Participants included adults without self-reported diabetes or chronic kidney disease in the National Health and Nutrition Examination Survey 1999–2006 who were aged ≥18 years of age and had complete blood counts, iron studies, and A1C levels. Iron deficiency was defined as at least two abnormalities including free erythrocyte protoporphyrin >70 μg/dl erythrocytes, transferrin saturation <16%, or serum ferritin ≤15 μg/l. Anemia was defined as hemoglobin <13.5 g/dl in men and <12.0 g/dl in women. RESULTS Among women (n = 6,666), 13.7% had iron deficiency and 4.0% had iron deficiency anemia. Whereas 316 women with iron deficiency had A1C ≥5.5%, only 32 women with iron deficiency had A1C ≥6.5%. Among men (n = 3,869), only 13 had iron deficiency and A1C ≥5.5%, and only 1 had iron deficiency and A1C ≥6.5%. Among women, iron deficiency was associated with a greater odds of A1C ≥5.5% (odds ratio 1.39 [95% CI 1.11–1.73]) after adjustment for age, race/ethnicity, and waist circumference but not with a greater odds of A1C ≥6.5% (0.79 [0.33–1.85]). CONCLUSIONS Iron deficiency is common among women and is associated with shifts in A1C distribution from <5.5 to ≥5.5%. Further research is needed to examine whether iron deficiency is associated with shifts at higher A1C levels. RESEARCH DESIGN AND METHODS We used data from the NHANES 1999–2006 conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention to assess the health and nutritional status of the U.S. population. The NHANES 1999–2006 included a nat Continue reading >>

Diabetes And Anemia:

Diabetes And Anemia:

There are lots of articles about diabetes, as well as all kinds of information about anemia. But what if you have both? About 25 percent of people with diabetes have some level of anemia. This article explains how the two conditions interact. What Is Anemia, and Why Is It Linked to Diabetes? In anemia, there are fewer red blood cells than normal, resulting in less oxygen being carried to the body’s cells. People with anemia often feel tired or weak and may have difficulty getting through activities of daily living. Other symptoms include paleness, poor appetite, dizziness, lightheadedness, rapid heartbeat, and shortness of breath. Because these symptoms can also be associated with diabetes, they are sometimes not recognized as evidence of anemia. Anemia may occur with diabetes because the hormone that regulates red blood cell production, erythropoietin (EPO), is produced by the kidneys. Kidney damage at several levels is a complication of diabetes, and one problem often leads to the other. Changes in the kidneys that occur with diabetes range from diabetic nephropathy all the way to chronic kidney disease. Early detection and treatment is essential to prevent or delay disease progression. Information in greater detail can be found at www.kidney.niddk.nih.gov. Other causes of anemia are low levels of iron or other vitamins, as well as prolonged illness. Diagnosing Anemia A simple blood test done during a doctor visit, called a complete blood count or CBC, is used to check for anemia. The two elements of the test that reveal anemia are hemoglobin and hematocrit. Hemoglobin is the part of red blood cells that carries oxygen to the cells. Hematocrit indicates the percentage of red blood cells in the blood. How Does Anemia Affect Your Diabetes Care? If you have anemia, you Continue reading >>

Iron: How This Supplement Could Impact Your A1c

Iron: How This Supplement Could Impact Your A1c

We need iron. Without enough iron, we’ll get sick. But too much iron can kill us. As with so many things relating to our health, it’s a balancing act. Most people who eat meat get sufficient iron. Some foods these days are also supplemented with iron. The chocolate syrup Bosco was designed to get children to consume more iron. Cooking in iron pots, especially cooking acid foods, adds iron to our diet. Multivitamins designed for younger people contain iron (especially those for pregnant women, as the fetus consumes a lot of iron). Hence nonpregnant Western people who aren’t vegetarians usually get enough iron from their diet. People in Third World countries who don’t get much meat, however, are often iron deficient. Heme iron, or the iron that is in hemoglobin, the oxygen-carrying molecule in red blood cells, is absorbed even more efficiently than the nonheme iron that you get when you eat vegetables or take an iron-containing multivitamin pill. So eating meat, especially red meat and liver, should ensure that you get enough iron. Vitamin C will increase the absorption of iron, and large amounts of calcium or whole grains will decrease it. Those of us over 60 probably remember all those ads for “tired blood” in the 1950s and 1960s that implied that older people were tired because they didn’t have enough iron and needed to supplement with Geritol. So should we all try to get as much iron as possible? Nope. There is some evidence that high iron levels contribute to heart disease, and most “senior vitamins,” designed for people who are at an age at which heart disease is more likely, don’t have any added iron. Some people think that losing blood every month helps to protect younger women from heart disease. This protection is lost after menopause. Iron l Continue reading >>

Factors That Interfere With Hba1c Test Results

Factors That Interfere With Hba1c Test Results

Information for physicians and patients regarding HbS, HbC, HbE and HbD traits More about hemoglobin variants and HbA1c can also be found at the NIDDK web site: Sickle Cell Trait and Other Hemoglobinopathies and Diabetes: Important Information for Physicians For People of African, Mediterranean, or Southeast Asian Heritage: Important Information about Diabetes Blood Tests Factors that Interfere with HbA1c Measurement: Genetic variants (e.g. HbS trait, HbC trait), elevated fetal hemoglobin (HbF) and chemically modified derivatives of hemoglobin (e.g. carbamylated Hb in patients with renal failure) can affect the accuracy of HbA1c measurements. The effects vary depending on the specific Hb variant or derivative and the specific HbA1c method. Table 1 contains information for most of the commonly used current HbA1c methods for the four most common Hb variants, elevated HbF and carbamylated Hb. Interferences from less common Hb variants and derivatives are discussed in Bry, et al [1]. All entries in Table 1 are based on published information. In addition, if a product insert indicates clearly that there is inference from a particular factor, then the interference is entered as “yes” and the product insert is cited. When selecting an assay method, laboratories should take into consideration characteristics of the patient population served, (e.g. high prevalence of hemoglobinopathies or renal failure). Factors that affect interpretation of HbA1c Results: Any condition that shortens erythrocyte survival or decreases mean erythrocyte age (e.g., recovery from acute blood loss, hemolytic anemia) will falsely lower HbA1c test results regardless of the assay method used [2]. HbA1c results from patients with HbSS, HbCC, and HbSC must be interpreted with caution given the patholog Continue reading >>

Effect Of Iron Deficiency Anemia On The Levels Of Hemoglobin A1c In Nondiabetic Patients.

Effect Of Iron Deficiency Anemia On The Levels Of Hemoglobin A1c In Nondiabetic Patients.

Abstract The major form of glycohemoglobin is hemoglobin A1c (HbA1c). The HbA1c fraction is abnormally elevated in chronic hyperglycemic diabetic patients and correlates positively with glycemic control. Previous studies suggest that iron deficiency anemia (IDA) affects the levels of HbA1c. The aim of this study was to determine the effect of IDA on HbA1c levels in nondiabetic patients. The population studied consisted of 50 patients (30 women, 20 men, mean age 35.7 +/- 11.9 years) with IDA and 50 healthy subjects that were matched for age and sex. Patients who had glucose tolerance abnormalities (impaired glucose tolerance or diabetes mellitus), hemoglobinopathies, hemolytic anemia, chronic alcohol ingestion and chronic renal failure were excluded from the study. Hematologic investigations, fasting and postprandial glucose and HbA1c levels were measured in all subjects before iron therapy. All patients with IDA were treated with iron 100 mg/day for 3 months. We repeated the laboratory investigation after iron therapy. Before iron treatment, the mean HbA1c (7.4 +/- 0.8%) level in patients with IDA was higher than in a healthy group (5.9% +/- 0.5) (p < 0.001). In patients with IDA, HbA1c decreased significantly after iron treatment from a mean of 7.4% +/- 0.8 to 6.2% +/- 0.6 (p < 0.001). Iron deficiency must be corrected before any diagnostic or therapeutic decision is made based on HbA1c. Continue reading >>

Artefactually Low Hemoglobin A1c In A Patient With Hemolytic Anemia

Artefactually Low Hemoglobin A1c In A Patient With Hemolytic Anemia

Hemoglobin A1C (HbA1C) is widely used for the monitoring and management of diabetes mellitus. Shortened red cell survival may result in artefactually low HbA1C values. In patients with hemoglobin variants or chemically-modified derivatives of hemoglobin, falsely decreased or increased HbA1C results may be found depending on the particular assay method. Although in most such cases, HbA1C can be reported if the appropriate methodology is selected. In diabetic patients with shortened red cell survival and in a small number of patients with certain hemoglobin variants, alternate approaches such as frequent glucose measurements and/or self glucose monitoring and fructosamine should be used to assess glycemic control. In diabetic patients with these conditions, HbA1C as the preferred diagnostic test for diabetes is not valid. Prekallikrein (Fletcher factor), a precursor of blood plasma kallikrein, is a glycoprotein consisting of 619 amino acid residues. Prekallikrein is synthesized in hepatocytes as a single polypeptide.1,2 Deficiencies of prekallikrein, factor XII (Hageman factor), high-molecular-weight (HMW) kininogen, and factor XI (plasma thromboplastin antecedent) affect the contact phase of coagulation. Despite abnormalities in coagulation tests including markedly prolonged activated partial thromboplastin time (aPTT), only factor XI deficiency is clinically relevant with a bleeding tendency, and a possible thrombophilia has been reported for factor XII deficiency.3–5 According to anecdotal reports, prekallikrein-deficient patients do not experience spontaneous or excessive injury-related bleeding; however, the marked prolongation of aPTT may be a diagnostic and management challenge for pathologists, hematologists, and surgeons with patients who undergo surgical proce Continue reading >>

Haemoglobin A1c And Iron Deficiency Anaemia Our Understanding Through The Decades

Haemoglobin A1c And Iron Deficiency Anaemia Our Understanding Through The Decades

Haemoglobin A1c and Iron Deficiency Anaemia our Understanding Through the Decades Haemoglobin A1c and Iron Deficiency Anaemia our Understanding Through the Decades Published Online: 2015-09-25 | DOI: HbA1c concentrations are affected by several factors including red blood cell turnover. The International Expert Committee has highlighted this observation for the benefit of physicians who evaluate HbA1c in diabetics. There are many types of anaemia that affect glycated haemoglobin (HbA1c) values but iron deficiency anaemia, one of the most common, has been proved to show higher than true values of HbA1c. The mechanism of how iron deficiency anaemia affects HbA1c has yet to be understood. Several studies have been conducted in order to unravel the mechanisms but there still remains a dearth of information. Future research needs to focus on the mechanistic reasons why HbA1c is higher in patients with iron deficiency anaemia in particular. This can pave the way for possible large scale studies to address the HbA1c enhancing effect and the mechanism of increased HbA glycation in iron deficiency properly. Keywords: diabetes ; haemoglobin ; iron deficiency anaemia ; HbA1c 1. Telen MJ, Kaufman RE. The mature erythrocyte function. In: Wintrobe`s Clinical Hematology, Greer JP, Foerster J (Eds), Lippincot Williams & Wilkins, Philadelphia, USA, pp 193-227, 1998. GoogleScholar 2. International Expert Committee. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care 32: 1327-1334, 2009. GoogleScholar 3. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 352(91 Continue reading >>

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